Interstitial cystitis (IC) also known as painful bladder syndrome (PBS) is described as pelvic pain, pressure or discomfort related to the bladder, typically associated with urinary frequency and urgency, in the absence of infection or other pathology. The exact cause of interstitial cystitis is unknown. Most believe the normal repair of the bladder does not occur in IC patients. Defects in the bladder allow urine contents to leak into the bladder lining, causing irritation and pain.
The most common symptoms of IC are urinary frequency in the day or night or both, urinary urgency, and pain usually in the lower abdomen, urethra or vagina that may be intensified with urination or sex. There is not a specific test for IC because symptoms are similar to other disorders of the bladder. It is important to rule out other causes of these symptoms, such as, urinary tract infections, bladder cancer and endometriosis. Some tests and tools that may assist in diagnosis are:
- Urine analysis
- PUF questionnaire
- Cystoscopy and hydrodistention
- Course of treatment
Treatment is usually multi-factorial and a stepwise approach is often used. There is no cure for IC so treatment is aimed at symptom relief. Treatment considerations may include:
- Diet modification some foods and drinks may be irritating to the bladder, examples include alcohol, tomatoes, spices, chocolate, caffeinated and citrus beverages, artificial sweeteners, carbonated beverages, etc.
- Bladder retraining in order to reduce frequency, try to empty bladder on a schedule, lengthening time between scheduled voids
- Over-the counter products Prelief, AZO, Cysta-Q, Calcium citrate, etc.
- Oral medications Elmiron, antidepressants, antihistamines, pain relievers, antispasmodics, antiseptics
- Bladder installations medications placed directly in the bladder to help reduce inflammation and provide relief of symptoms
- Pre tibial nerve stimulation (PTNS) - emits electrical impulses to nerves in the lower back to help manage IC symptoms
- Bladder distention is used as a diagnostic test sometimes and may give some symptom relief initially.
- Surgery last resort
- Experimental acupuncture, Botox, Uracyst, URG-101 installations
More information is available at the following sites:
Interstitial Cystitis Association
American Urologic Association
National Institute of Diabetes and Digestive and Kidney Disease
American Urogynecologic Society